A síndrome de Guillain-Barre (SGB) e outros distúrbios neurológicos são fortemente associados ao vírus Zika, suspeitando-se que sejam causados por este, mas a ligação ainda não foi estabelecida e estão sendo realizados estudos, que procuram também elucidar sobre o possível mecanismo.[10]Dos Santos T, Rodriguez A, Almiron M, et al. Zika virus and the Guillain-Barré syndrome - case series from seven countries. N Engl J Med. 2016 Oct 20;375(16):1598-601.
http://www.nejm.org/doi/full/10.1056/NEJMc1609015?query=featured_zika
http://www.ncbi.nlm.nih.gov/pubmed/27579558?tool=bestpractice.com
[11]Parra B, Lizarazo J, Jiménez-Arango JA, et al. Guillain-Barré syndrome associated with Zika virus infection in Colombia. N Engl J Med. 2016 Oct 20;375(16):1513-23.
http://www.nejm.org/doi/full/10.1056/NEJMoa1605564#t=article
http://www.ncbi.nlm.nih.gov/pubmed/27705091?tool=bestpractice.com
[12]Frontera JA, da Silva IR. Zika getting on your nerves? The association with the Guillain-Barré syndrome. N Engl J Med. 2016 Oct 20;375(16):1581-2.
http://www.nejm.org/doi/full/10.1056/NEJMe1611840
http://www.ncbi.nlm.nih.gov/pubmed/27705077?tool=bestpractice.com
[13]Leis AA, Stokic DS. Zika virus and Guillain-Barre syndrome: is there sufficient evidence for causality? Front Neurol. 2016 Sep 30;7:170.
http://journal.frontiersin.org/article/10.3389/fneur.2016.00170/full
http://www.ncbi.nlm.nih.gov/pubmed/27746763?tool=bestpractice.com
As evidências para dar suporte a uma relação causal se expandiram nos últimos anos; no entanto, o corpo de evidências ainda é menor do que para anomalias congênitas.[9]Counotte MJ, Meili KW, Taghavi K, et al. Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: a living systematic review. F1000Res. 2019 Aug 14;8:1433.
https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6852328
http://www.ncbi.nlm.nih.gov/pubmed/31754425?tool=bestpractice.com
As complicações neurológicas são raras e foram relatadas em 0.3% dos casos, sendo a complicação mais comum a SGB.[46]Halani S, Tombindo PE, O'Reilly R, et al. Clinical manifestations and health outcomes associated with Zika virus infections in adults: a systematic review. PLoS Negl Trop Dis. 2021 Jul;15(7):e0009516.
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0009516
http://www.ncbi.nlm.nih.gov/pubmed/34252102?tool=bestpractice.com
Evidências sugerem que a incidência de SGB é de 24 casos por 100,000 pessoas infectadas com Zika.[45]Uncini A, Shahrizaila N, Kuwabara S. Zika virus infection and Guillain-Barré syndrome: a review focused on clinical and electrophysiological subtypes. J Neurol Neurosurg Psychiatry. 2017 Mar;88(3):266-71.
https://jnnp.bmj.com/content/88/3/266.long
http://www.ncbi.nlm.nih.gov/pubmed/27799296?tool=bestpractice.com
A recuperação é variável; alguns pacientes recuperam a saúde, enquanto outros apresentam incapacidade crônica.[46]Halani S, Tombindo PE, O'Reilly R, et al. Clinical manifestations and health outcomes associated with Zika virus infections in adults: a systematic review. PLoS Negl Trop Dis. 2021 Jul;15(7):e0009516.
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0009516
http://www.ncbi.nlm.nih.gov/pubmed/34252102?tool=bestpractice.com
Casos de mielite aguda, meningoencefalite e encefalomielite disseminada aguda foram relatados em pacientes com infecção pelo vírus da Zika.[216]American Academy of Neurology. Zika virus may now be tied to another brain disease. Apr 2016 [internet publication].
https://www.aan.com/PressRoom/Home/PressRelease/1451
[217]Barcellos C, Xavier DR, Pavão AL, et al. Increased hospitalizations for neuropathies as indicators of Zika virus infection, according to health information system data, Brazil. Emerg Infect Dis. 2016 Nov;22(11):1894-9.
https://wwwnc.cdc.gov/eid/article/22/11/16-0901_article
http://www.ncbi.nlm.nih.gov/pubmed/27603576?tool=bestpractice.com
[218]Soares CN, Brasil P, Carrera RM, et al. Fatal encephalitis associated with Zika virus infection in an adult. J Clin Virol. 2016 Oct;83:63-5.
https://www.sciencedirect.com/science/article/pii/S1386653216305133
http://www.ncbi.nlm.nih.gov/pubmed/27598870?tool=bestpractice.com
[219]Niemeyer B, Niemeyer R, Borges R, et al. Acute disseminated encephalomyelitis following Zika virus infection. Eur Neurol. 2017;77(1-2):45-6.
http://www.ncbi.nlm.nih.gov/pubmed/27894121?tool=bestpractice.com
Foi relatado um caso de polineuropatia desmielinizante aguda de rápido desenvolvimento enquanto o vírus Zika ainda estava presente no soro do paciente.[120]Siu R, Bukhari W, Todd A, et al. Acute Zika infection with concurrent onset of Guillain-Barré syndrome. Neurology. 2016 Jun;7(2):220.
http://www.neurology.org/content/early/2016/07/27/WNL.0000000000003038.long
http://www.ncbi.nlm.nih.gov/pubmed/27466468?tool=bestpractice.com
Foi relatada polineuropatia sensorial aguda em um paciente durante a fase infecciosa ativa.[220]Medina MT, England JD, Lorenzana I, et al. Zika virus associated with sensory polyneuropathy. J Neurol Sci. 2016 Oct 15;369:271-2.
http://www.ncbi.nlm.nih.gov/pubmed/27653905?tool=bestpractice.com
Foram relatados abortos espontâneos por algumas mulheres com infecção pelo vírus da Zika.[221]van der Eijk AA, van Genderen PJ, Verdijk RM, et al. Miscarriage associated with Zika virus infection. N Engl J Med. 2016 Sep 8;375(10):1002-4.
https://www.nejm.org/doi/full/10.1056/NEJMc1605898
http://www.ncbi.nlm.nih.gov/pubmed/27463941?tool=bestpractice.com
Pode ser uma possível manifestação de infecção pelo vírus Zika de acordo com relatos de caso.[222]Furtado JM, Espósito DL, Klein TM, et al. Uveitis associated with Zika virus infection. N Engl J Med. 2016 Jul 28;375(4):394-6.
http://www.nejm.org/doi/full/10.1056/NEJMc1603618
http://www.ncbi.nlm.nih.gov/pubmed/27332784?tool=bestpractice.com
[223]Kodati S, Palmore TN, Spellman FA, et al. Bilateral posterior uveitis associated with Zika virus infection. Lancet. 2017 Jan 7;389(10064):125-6.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32518-1/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/27939402?tool=bestpractice.com
O humor aquoso no olho do paciente foi positivo para RNA do vírus da Zika na reação em cadeia da polimerase via transcriptase reversa. Foram relatados dois casos de uveíte aguda anterior bilateral hipertensiva relacionada a Zika.[224]Merle H, Najioullah F, Chassery M, et al. Zika-related bilateral hypertensive anterior acute uveitis. JAMA Ophthalmol. 2017 Mar 1;135(3):284-5.
http://www.ncbi.nlm.nih.gov/pubmed/28152146?tool=bestpractice.com
Um caso de miocardite transitória foi associado à infecção pelo vírus Zika.[225]Aletti M, Lecoules S, Kanczuga V, et al. Transient myocarditis associated with acute Zika virus infection. Clin Infect Dis. 2017 Mar 1;64(5):678-9.
https://academic.oup.com/cid/article/64/5/678/2666524
http://www.ncbi.nlm.nih.gov/pubmed/27940942?tool=bestpractice.com
Outras possíveis complicações cardíacas relacionadas à infecção pelo vírus Zika são arritmias, insuficiência cardíaca e derrame pericárdico.[226]Gonzalez Carta KA, Mendoza I, Morr I, et al. Myocarditis, heart failure and arrhythmias in patients with Zika. Presented at American College of Cardiology 2017 Annual Conference; Mar 17-19, 2017; Washington, DC.
Um estudo sugere que a infecção congênita pelo vírus Zika pode estar associada a um aumento do risco de cardiopatia congênita, embora mais pesquisas sejam necessárias.[227]Cavalcanti DD, Alves LV, Furtado GJ, et al. Echocardiographic findings in infants with presumed congenital Zika syndrome: retrospective case series study. PLoS One. 2017 Apr 20;12(4):e0175065.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175065
http://www.ncbi.nlm.nih.gov/pubmed/28426680?tool=bestpractice.com